BIM24655 - Mutual associations: specific activities: NHS doctors' co-operatives

Introduction and layout of guidance

Prior to April 2004 General Practitioners’ (GP) contracts with the NHS required the GP to ensure their patients had 24 hours a day access to appropriate medical care. This means that outside normal surgery hours GPs had to provide emergency medical care for their patients. GPs could do this either personally or through a properly qualified deputy.

In 1995 arrangements were introduced to ease the burden on GPs of providing out-of-hours cover. The 1995 changes resulted in a significant increase in the number of GP co- operatives (where doctors group together in a rota) set up to provide out-of-hours services.

Some of the co-operatives have formally established themselves as companies, most frequently companies limited by guarantee. Other co-operatives have a less formal structure. Some co-operatives have established treatment centres where patients can be seen out-of- hours.

As an initial step you need to consider two interrelated questions:

• whether the co-operative is carrying on a trade, and
• if the co-operative is trading, the extent to which that trade is a mutual trade.

The typical GP co-operative is organised on a ‘not for profit’ basis. The absence of a profit- seeking motive does not preclude a finding of trading - see BIM24045.

On 1 April 2004 the new General Medical Services contract meant that GPs could opt out of providing out of hours patient cover and responsibility for providing this service transferred from GPs to Primary Care Trusts or Primary Care Organisations. Consequently, in the majority of cases out of hours cover is no longer provided by the GP practice - see BIM24671.

The guidance that follows covers: